Clinical Practice Guidelines for Rhabdomyolysis: Management and Recommendations

Rhabdomyolysis is a condition with a significant impact on kidney function, requiring prompt clinical management to prevent morbidity and mortality. This article discusses the prevalence, patient population criteria, admission criteria, treatment options, and potential complications associated with rhabdomyolysis. It emphasizes the importance of early intervention, particularly with intravenous fluid administration, to prevent renal failure. By following standardized care guidelines, healthcare providers can effectively manage rhabdomyolysis cases and improve patient outcomes.

• Rhabdomyolysis Management
• Clinical Guidelines
• Kidney Injury
• Treatment Recommendations
• Complications Prevention

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1. Banner Clinical Practice: Rhabdomyolysis ZACHARY SPRAGUE, DO BETHANY BRUZZI, DO JUNE 7, 2018

2. Prevalence United Stated: approximately 26,000 cases annually Approximately 7 to 10% of all cases of acute kidney injury in the United States are due to myoglobinuria associated AKI. The incident of AKI in rhabdomyolysis has been reports to range between 13 to 50% but is difficult to establish a true rate due to varying definitions and clinical scenarios

3. Why Do We Need a Standard of Care? The primary purpose of these guidelines is to decrease morbidity and mortality rates of rhabdomyolysis by presenting recommendations for clinical management that can be applied to individual cases if deemed appropriate by the treating physician.

4. Patient Population Inclusion Criteria Adults great than 18 years of age Signs and symptoms (H&P) consistent with diagnosis of Rhabdomyolysis Exclusion Criteria Younger than 18 years of age History of End Stage Renal Disease History of Chronic Heart Failure

5. Admission Criteria 1. Creatinine Kinase greater than five times the upper limit of normal6(Observation is appropriate for anyone who meets greater than 5x upper limit normal (1000) to 5000, and did not correct despites IV fluids. Admit to inpatient if greater than 10K. Consider Inpatient status for anyone 5001-9999 and rising.) 2. Continuously increasing CK despite intravenous fluid protocol 3. Laboratory finding consistent with AKI or electrolyte abnormalities(such ranges that would warrant obs/inpt for those diagnosis (ex) creatinine at least 1.5x baseline) 4. Concern for oliguria(<0.5 ml of urine per kilogram per hour for 12 hours), anuria, or volume overload 5. Need for Renal Replacement Therapy 6. Clinical signs of compartment syndrome

6. Treatment Intravenous Fluids: Intravenous hydration should be initiated immediately upon clinical suspicion as the delay of treatment can lead to oliguric renal failure and eventually anuric renal failure.13An initial 1-2L bolus of normal saline should be given followed by a intravenous fluid rate of 400ml/hr titrated to a urine output of 200-300ml/hr.6,31 Mannitol and Loop diuretics are not effective

7. Complications AKI/ARF Hyperkalemia Hypocalcemia and hypercalcemia Hyperphosphatemia Hyperuricemia Hypovolemia

8. Discharge Criteria ED 1. Creatinine Kinase downtrending 2. Creatine Kinase less than 1,000. 3. Urine dipstick negative for blood 6(Unlikely to be positive with values less than 1000, if high pos on dipstick, may consider observation with risk of increased values though rather than discharge) 4. Electrolytes within normal ranges 5. No clinical signs of compartment syndrome 6. Clinically euvolemic

9. Discharge Criteria Medicine 1. Creatinine Kinase downtrending 2. Creatine Kinase less than 10,0009,15,36 3. Urine dipstick negative for blood 6 4. Electrolytes within normal ranges 5. No clinical signs of compartment syndrome 6. Clinically euvolemic

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